HomeMy WebLinkAbout12-22-05
REV-l500 5X + (6-00)
'* COMMONWEALTH OF
. PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.{)601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAl)
Vierin , Ellena M.
DATE OF DEATH (MM-DO-Year)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DATE OF BIRTH (MM-DD- Year)
05/01/2005 06/19/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAl USE ONLY
FILE NUMBER
2 1 -0 5 4 2 2
COiiNTvCOiiE -YEAR- - - NUMBER- -
SOCIAL SECURITY NUMBER
1 84- 0 7 - 4 1 9 2
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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00 1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (AltachcopyofWilI)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (daleofdealh a/ler12.12-82)
o 7. Decedent Maintained a Living Trust (AIlach copy of Trust)
o 10. Spousal Poverty Credit (dale ofdealh between 12.31.91 and 1.1-95)
o 3. Remainder Retum (dale of dealh prior m 12-13-82)
o 5. Federal Estate Tax Retum Required
Q. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AIlachSch0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Wa e F. Shade 53 West Pomfret Street
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717-243-0220
Carlisle
PA 17013
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
(1)
(2)
(3)
(4)
(5)
99,627.14
OFFICIAL USE ONLY
'" .;
~"'-;
r'.)
8,981.80
858.33
I.._()
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Proparty (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 nlinus Line 11)
13. Charitable and Govemmental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(n
(8)
109,467.27
23,461.84
10,629.47
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00
75,375.96
0.00
0.00
X _(15) 0.00
X .045 (16) 3,391.92
X .12 (17) 0.00
X .15 (18) 0.00
(19) 3,391.92
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(11)
(12)
(13)
34,091.31
75,375.96
(14)
75,375.96
> > BE SURE TO ANSweR ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
pt.
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I t Add
ece en s omple e ress:
STREET ADDRESS 99 Buttermilk Road
CITY N 'Il I STATE PA I np 17241
eWVI e
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,391.92
3.200.00
168.42
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
3,368.42
Total Interest/Penalty (0 + E) (3)
4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BAlANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income ofthe property transferred; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ........... ........................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.... .......................................................................................... 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
0.00
0.00
23.50
23.50
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
PA 17241
,~TE
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PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)l.
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The ~ rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an
indiy,Wcll who has at least one Darent in common with the decedent. whether bv blood or adootion.
1,..-,
REV-1502 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Viering. Ellena M 21 05 422
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, r:either being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real ro which is' i -owned with . ht of survivorshi must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
,
d
TOTAL (Also enter on line 1, Recapitulation) $
(If mnl'P. ~Mr.P. "" nAP.ltP./1 in~Art llc1c1itinnlll !lhAAR nf thA!:lImP. !li7Al
99,627.14
A. Settlement Statement
B. Type of Loan
1. o FHA
4. OVA
2. 0 FmHA
5. 0 Cony. Ins.
3. 0 Cony. Unlns File Number
05-23
U.S. Oepanment of Housillll
and Urtan Development ~
,r
OMB No. 2502-0265
Mortgage Insurance Case Number
C. NOTE:This form is fumished to give you a statement of aetualsettlement costs. Amounts paid to and by the settlement agent are shown.
Items mar1<ed 'p.o.c' were paid outaide of closing: they are shown here for Informational purposes and are not Included in the totals.
o NAME AND ADDRESS OF BORROWER: G~ S. C/a/1( Amber D. CIa/1(
. 234 Green Hili Road, Newville, PA 17241 234 Green Hili Road, Newville, PA 17241
E. NAME AND ADDRESS OF SELLER:
Estate of Ellana M. V1erlng
100 Buttennllk Road, Newville, PA 17241
F. NAME AND ADDRESS OF LENDER:
Accredited Home Landers
P.O. Box 11U36, Van Nuys, CA e141lJ.1U36
G. PROPERTY
LOCATION:
ee Buttermilk Road
Newville, PA 17241
H. SETTLEMENT AGENT:
PLACE OF SETTLEMENT:
TIN:
uw Of/Ice of Andnw H. Shaw
61 Wat Louther Street, C.rlta'" PA 17013
33-1098609
I. SETTLEMENT DATE: 1011312005 RESCISSION DATE:
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price ," nn . nnn nn 401. Contract Sales Price $100 000.00
102. Personal Property 402. Personal property
103. SettIemsnts charges to borrower. 403.
(from Una 1400) $7,980.32
104. 404.
105. .. 405.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
106. CiIyIIDwn taxes to 406. CIlyIlDwn T_ to
.107. Coun!yT_ 10/13/2005 to 01/01/2006 $32.40 407. CountyT_ 10/13/2005 to 01/01/2006 $32.40
106. AIMaamenta 10/13/2005 to 07/01/2006 $594.74 408.~ta 10/13/2005 to 07/01/2006 $594. 74
10.. 40..
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER: $108,607.46 420. GROSS AMOUNT DUE TO SELLER: $100,627.14
200. AMOUNTS PAID BY ORIN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or _t money $1,000.00 501. Excess deposit (He Inslructions) $1,000.00
202. Principal amount of n_loan(s) $97,500.00 502. Settlement cNIl'l18S to saller Pine 1400) $1,000.00
203. Existing Ioan(s) talcen subject to 503. EJdstIna Ioan(s) taken sublect to
204. 504. Payoff of first mortgage loan
205. 505. PayoIf of I8COIld lIlOI1gageloan
206. 506.
207. 507.
208. 508.
20.. 50S.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
210. Cllyltown taxes to 510. CllyIlDwn taxes to
211. County taxes 10 511. Countvtaxes 10
212. AasessrnenlS to 512. Assessments to
213. . 513.
214. 514.
.215. 515.
216. 516.
217. 517.
218. 518.
21.. 519.
220. TOTAL PAID BY/FOR $98,500.00 520. TOTAL REDUCTIONS $2,000.00
BORROWER: IN AMOUNT DUE TO SELLER:
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER
301. Gross amount due from borrower (line 120) '108,607.46 601. Gross amount due to seller (line 420) $100,627.14
302. Less amount paid bylfor borrower (line 220) $98,500.00 602. Less reductions in am!. due seller (line 520) $2,000.00
303. CASH ( ~FROM) ( DTO) BORROWER: $10,107.46 603. CASH ( o FROM) ( ~TO) SELLER: $98,627.14
HUD-1 (3-86) . RESPA, HB 4305.2
PAGE 1
HUQ-l (Rev 3/86)
L
SETTLEMENT CHARGES
OMS No. 2502.0266
700. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FROM
BASED ON PRICE $100,000,00 @ 'II- BORROWER'S SELLER'S
FUNDS FUNDS
DIVISION OF COMMISSION (LINE 700) AS FOLLOWS; AT AT
701. 10 SETTLEMENT SETTLEMENT
702. 10
703. 10
704. 10 .
705. Comminkln paid .t _nlement
706.
800. ITEMS PAYABLE IN CC NNECTION WI H LOAN:
801. loan origination fee 'II 10 CCIIIIIIIOI1.....a.l th Funding $2,957.50
602. Loan diSCOtXll 'II to Accredited Hom.. LendAtr..
803. Appraisal fee to: Accredi t..d Home LendAtr..
804. Credit report to: COIIIIllOu.....al th Funding --:- $30.00
80S. lender'a inspection fee Ac:c:redi teet Home L\8l1der.
806. Mortgage insuranc. application fee to Accred1. tad Home Le.nder.
807. AalUnption fee Accredi tad HODI4it Lender.
808. Service Clurge to Cama. I'undina(ADDrai...l) $500.00
809. S..rvic.. Clurg.. to Accr..dited HOIII8 Lencfar.. $1,B45.50
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE.
901.lnIeroatfrom 10/13/2005 10 11/01/2005
902. Mortgege insurance premium for mol. 10
903. Hazard inu"ance premium for yrs. to
904. Flood in.nne. premium for yrs. 10
905.
1000. RESERVES 0 POSITED WITH N
o
$20.03/dI<f
$3BO.57
1001. Haz.'d inIu'..-.ce
1002. Mortgage inaurence
1 003. City proporty .....
10004. County property laxe.
1005. AnnuaI....uments
1006. Flood inlw80Ce
1007.
1008.
1~. Aggregate Accounting
11 I L HA
1101. S._orclooingfMto La... O~~ic.. o~ Andr..... H. Sba...
1102. Abltracl or oo....-ch to
1103.TItIe~lo
1104. TIUe ir1au'8nce binder to
1105. Doc:un.o_1o
1106. NoIaty_1o
1107. Attorney'. fees to
(includeo_ items N_:
1108. TttJo iNuronco to Security Titl.. Guarant... CCzporation
("""'---_N...-.: 1102, 1107, 110B
1109. lender'. eovwage
1110. Ownoo'. 00YeI1Ig0
1111. Endor.._t.. 100, 300, B.l, 710
1112. Cl.o..ing Protection L..tter
1113.
""'"""0
-0
manlha 0
-0
-0
-0
-10
monthoO
Escrow Adjustment
per monIh
per _
per month
por monIh
per _
permonlt1
per mcnIh
per _
Andr..... H. 8ha...
$20.00
12. NM N R
1201. Rooordlng_:
1202. Cityico<Jnty 1oxI1lampo:
1203. SIoIO loxIItampo:
1204.
1205.
13 . NAL L M
1301. Survey 10
1302. Pelt inspection 10
1303. Tax Certii'ica tion
1304. Wire Serrice Fe.
I
Deed
$46.50 :Mortgogo $76.50
Deed $l,OOO.OO:Mortgogo
$1,000.00 ;Mortgogo
:R_
$123.00
$1,000.00
$97,500.00 )
Deed
: 0tIler
$1,000.00
1305. OVernight F..e..
1306.
1307.
$5.00
$10.00
$15.00
1400. TOTAL SETTLEMENT CHARGES $7, 9BO. 32 $1,000.00
I have carefully reviewed the HUD.l Settlement Statement and to the best of my knowtedge and belief, It is altue and accurate statement of all recelpts and disbursements made
on my a<:count or by me In this transaction. I further certify that I have received a copy of the HUD-l Settlement Statement.
Gregory S. Clark
Date:
:or d/~/~ ,t~ft f!t
Estale of Ellena M. Vier/ng .
Date: /ar13/oo
Borrower:
Amber D. Clark
Date:
Seller or
Agent
Date:
Borrowe,
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance
with this statement.
Date:
SettleMent Agent
Date:
Andrew Shaw
WARNING: It is a crime to knowingly make false statements to the Untted States on this or any other similar form. Penalties upon conviction can Include a fine and imprison-
ment. For details see: TIde IS U.S. Code Section 1001 and Section 1010.
REV-1508 EX + (6-98)
'*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Viering. Ellena M.
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
6
2.
Penn Treaty Network America Ins. Co., health insurance premium refund
3.
Foot Locker, Inc., retirement
4.
The Sentinel, subscription refund
5.
Adams Electric Cooperative, Inc., patronage refund
6.
Household contents
7.
Presbyterian Homes, refund of patient co-insurance
8.
Pennsylvania Department of Revenue, real estate tax rebate
9.
Judith E. Clark, Home Depot credit
10.
Harleysville Insurance, homeowner's insurance premium refund
11.
Mark D. Eberly, purchase of table and chairs
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
422
VALUE AT DATE
OF DEATH
5, 0
444.22
104.10
7.00
310 .44
1,431.00
305.55
405.60
274.54
64.75
150.00
8,981.80
Niles M. Miller
Financial Services
Financial Consultant
Life · Health · Investments*
928 Greenbriar Drive
Mechanicsburg, P A 17050
(717) 691-3454
1-800-428-9500
Fax (717) 697-7090
June 16, 2005
Wayne F. Shade
Attorney at Law
53 West Pomfret Street
Carlisle, P A 17013
Re: Estate of Ellena M. Viering
Alliance Bernstein Account #55/5600001416
Dear Mr Shade,
This letter is to inform you that on May 1, 2005 when Ellena M. Viering died, her account
value was $5,484.60 with 747.221 total shares and the price per share was $7.34.
Please call me if you have any other questions.
Sincerely,
.~~~~~
Niles M. Miller
*Investment Advisor Representah'lJe with and securities offered throllgh
InterSecurities. Inc.. Member NASO. SIPC
5320 Jaycee Avenue. Harrisburg. PA 17112 · (717) 540-5690
B~ ROWE:~~}~~t
08 . AU 2276L
R. D. 4, Box 353 · Carlisle, P A
249-2677 249-1978
Auction Is Action Call "ROWE"For Satisfaction
May 23, 2005
TO: Wayne Shade
Attorney
53 West Pomfret st.
Carlisle, Pa. 17013
FOR: Judith Clark
Executrix
100 Buttermilk Road
Newville,Pa 17241
FR: Benny Rowe
Appraiser/Auctioneer
2505 Ritner Highway
Carlisle, Pa. 17013
RE: Ellena Viering Estate, 99 Buttermilk Road, Newville,
Pa., Personal property appraisal at current auction
market value.
PAGE 2
KITCHEN/ENCLOSED PORCH
Washer/Dryer
Deep Freezer
Misc.
Oakside/Side Combo
Hat Rack
Work tablet Chairs
Microwave
Misc. top of Cupboards
Misc. Household Access. & decorators
Refrigerator
Side Cabinet
$ N/V
N/V
5.00
215.00
5.00
5.00
15.00
45.00
30.00
65.00
30.00
LIVING ROOM
Entertainment Center, TV, VCR, Cabinet
Oak Sideboard
Shelf Clock
2 Pes. Living Room suite
Pole Light
Relining Chair
Knick Knacks, Misc.
65.00
210.00
90.00
45.00
1 .00
N/V
5.00
BEDROOM DOWNSTAIRS
3 Pes. Cherry Bedroom suite
Step End stand
Handicap Helpers
Misc. Small Items
265.00
1.00
5.00
5.00
UPSTAIRS BEDROOM #1
Oak Lamp table, Square
Round Lamp table - Empire
Sewing Machine Electric
Wicker Plant stand
Oak rocker
Book shelf
Table, Floor Lights
Treadle Sewing Machine
Wing Chair
Misc.
20.00
. 20.00
N/V
2.00
7.00
5.00
2.00
20.00
N/V
4.00
PAGE 3
BEDROOM #2
Metal Bed
Cottage Chest of Drawers
Floor Light
Milk Can
Fan
X-Cycle
Misc.
$ N/V
30.00
2.00
6.00
3.00
N/V
6.00
BEDROOM # 3
Oak Dresser Base
Rocking Chair
Cedar Wardrobe
Chairs
Shelf
Books
Floor Light
Shampooer
Misc.
10.00
12.00
60.00
3.00
4.00
N/V
2.00
N/V
6.00
BASEMENT
2 Crocks
Jug
Aqua Jars
18.00
20.00
10.00
TOTAL $1431.00
Q~
Benny E. Rowe
REV-1509 EX'" (6-98)
'*
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Viering. Ellena M.
FILE NUMBER
21 05
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
422
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
Daug ter
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INS f1TUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 12/1/84 Adams County National Bank, Checking Account 758.01 50. 379.01
#132683
2. A. 10/7/02 Members 1st Federal Credit Union, Account #75460 958.63 50. 479.32
TOTAL (Also enter on line 6, Recapitulation) $ 858.33
(If more scace is needed. insert additional sheets of the same sizel
~ ADAMS COUNlY
NATIONAL BANK
May 27, 2005
Wayne F. Shade
Attorney at Law
53 West Pomfret Street
Carlisle, P A 17013
Re: Estate of Ellena M. Viering
Dear Mr. Shade:
The following information is being provided as per your request:
Acet. Type Account
No.
Account
Principal on
D.O.D.
$757.57
Accrued
Interest to
D.O.D.
$.44
Ownership
Date
Account
Opened
5-15-85
Checking 132683
Jt. wi Judith E
Clark
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer
Company at 1-800-368-5948. If you need any additional information, please contact me at (717)338-2171.
Sincerely,
Y-;oW I~~
Lois Ki~e
Deposit Services
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interestto Date of Death .
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
Account Registration
Account Ownership
Estate of: ELLENA M. VIERING
Date of Death: 05/01/2005
Social Security Number: 184-07-4192
rvl~
MEMBERS 1st
FEDERAL CREDIT UNION
75460 -00
07/28/1965
$958.63
$.00
$958.63
Judith E. Clark
10/07/2002
Right of Survivorship
Non-Transferable
~E ERS 1ST FEDERAL CREDIT UNION
~ c::1/U~
e ise A. Wolfe ~ / .
Insurance Services Supervisor
May 27, 2005
5000 Louise Drive. P.o. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.memberslst.org
REV-1511 EX+(12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Vierin9. Ellena M
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
05
422
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoffman-Roth Funeral Home, Inc., funeral expenses 7,909.60
2. St. Mary's United Methodist Church, funeral reception 300.00
3. Eby Granite Works, grave marker 3,566.00
4. Eby Granite Works, vases for tombstone 300.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (3)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Wayne F. Shade, Esquire 7,500.00
3. Family Exemption: (If decedenfs address is rot the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decede1t
4. Probate Fees Register of Wills of Cumberland County, P A 177.00
5. Accountanfs Fees
6. Tax Return Prepare(s Fees
7. Harleysville Insurance Company, homeowner's insurance premium 108.25
8. Cumberland Law Journal, advertise Letters Testamentary 75.00
9. Rowe's Antiques, personal property appraisal 85.00
10. Shipley Energy, propane 76.92
11. Adams Electric Cooperative, Inc., electric service 86.20
12. Diversified Appraisal Services, appraisal 275.00
13. The Sentinel, advertise Let1ers Testamentary 129.77
14. Sprint, telephone service 24.46
15. Shelby Winter, school real estate taxes 818.12
16. Adams Electric Cooperative, Inc., electric service 56.63
17. Franklin Real Estate Services and Abstracting Company, Inc., title examination 150.00
18. Adams Electric Cooperatiw, Inc., electric service 32.24
TOTAL (Also enter on line 9, Recapitulation) $ 23,461.84
(If more space is needed, insert additional sheets of the same size)
Viering, Ellena M.
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 05 422
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
AMOUNT
19.
20.
21.
22.
23.
24.
25.
26.
DESCRIPTION
Harleysville Insurance, homeowner's insurance premium
Adams Electric Cooperative, Inc., electric service
Scott Clark, lawn care
Adams Electric Cooperative, Inc., electric service
Adams Electric Cooperative, Inc., electric service
Donald K. Eberly, water heater replacement
Register of Wills, file inherit.mce tax return
Register of Wills, reserve for filing account, etc.
108.25
34.06
595.15
31.85
22.34
585.00
15.00
400.00
SUBTOTAL SCHEDULE H-B7
1,791.65
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
VierinQ. Ellena M.
FILE NUMBER
21 05
422
Include un reimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. West Shore EMS, unreimbursl~d medical expense
VALUE AT DATE
OF DEATH
110.61
2. Department of Public Welfare, restitution of medical assistance
10,518.86
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,629.47
.OEV'''''~.I'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Ellena M. ?1 05 4??
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Carolyn E. Blain Lineal
74 McAllister Church Road
Carlisle, P A 17013
2. Barbara A. Fraker Lineal
4141 Enola Road
Newville, PA 17241
3. Mary Ellen Nailor Lineal
507 Shed Road
Newville, PA 17241
4. Judith E. Clark Lineal
100 Buttermilk Road
Newville, PA 17241
5. Beverly J. Pease Lineal
79 Innes Ridge Road
Wayne, ME 04284
6. Jacquelyn L. Meals Lineal
344 Dubling Gap Road
Newville, P A 17241
7. Kimberly A. Shumaker Lineal
101 Eddington A venue
Harrisburg, P A 17111
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more s~ace is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Viering, Ellena M.
Decedent's Name
Page 2
21 05 422
File Number
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OFEST ATE
I TAXABLE DISTRIBUTIONS (include outright spoJsal distributions)
8. Nelson L. Viering, III Lineal
349 Braddock Drive
Etters, PA 17319
....
I, Ellena M. Viering, of R.D. #3, Box 1938, Newville,
Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby
revoking any and all other wills and codicils heretofore made by
me.
FIRST. I direct that. all my just debts and funeral
expenses be paid from my estate as soon after my death as
practically and conveniently may be done.
~r.:t.:ONiJ. I direc"t: tnat my remains be interred wi t:lun my
~amily's burial plot located at Brick Church Cemetery, R. D. #3,
Newville, Pennsylvania.
THIRD. I authorize my personal representative to expend
funds from my estate, in such amounts as my personal
representative shall consider necessary and desirable for the
purchase, erection and inscription of a suitable marker for my
grave.
FOURTH. I give, devise and bequeath any and all tangible
personal property owned by me at the time of my death unto my
children, Carolyn E. Blaine, Nelson L. Viering, Jr., Barbara A.
Fraker, Mary Ellen Nailor, Judith E. Clark, Beverly J. Pease,
and Jacquelyn L. Meals, in equal shares per stripes.
FIFTH. I give, de~Jise and bequeath any and all real es.tate
owned by me at the time of my death, unto my.children, Carolyn
E. Blaine, Nelson L. Viering, Jr., Barbara A. Fraker, Mary Ellen.
Nailor, Judith E. Clark, Beverly J. Pease, and Jacquelyn L.
Heals, in equal shares per stripes.
SIXTH. I give, devise and bequeath all the rest, residue
. anci remainder .or my os'cate unt:o my children, Carolyn E. Blaine,
Nelson L. Viering, Jr., Barbara A. Fraker, Mary Ellen Nailor,
Judith E. Clark, Beverly J. Pease, and Jacquely~ L. Meals, in
equal shares per stripes.
SEVENTH. I direct that any and all Inheritance, Estate and
Transfer taxes imposed upon my estate passi~g under my will or
otherwise, shall be paid out of the principal of my residuaLY
estate.
EIGHTH. I hereby nominate, constitute and appoint my
daughter, Judith E. Clark, as Executor of this my Last Will and
Testament to serve without compensation. I hereby relieve my
Executor from the necessity of posting security in connection
with her duties, CiS such, in any jur1sdiction in which she may
be called upon to act insofar as I am able by law to do so. In
addition to the powers conferred by law, I authorize my
Executor, in her absolute discretion, to retain in the form
received, and to sell either at public or private sale
any real or personal property owned by me at the time of my
death.
IN WITNESS WHEREOF, I have hereunto set
this, my Last Will and Test~ent, c~sting
pages this ~ Q) day of ~ ~ .
UA4( )Jl ~~~~~ q
Ellena M. Viering /II
L/
my hand and seal to
of two typewri~ten
1988.
Signed, sealed, published and declared by the above named
Testatrix Ellena M. Viering as and for her Last Will and
Testament, in the presence of us, who, at her request, in her
sight and presence and in the sight and presence of each other,
have hereunto subscribed our names as witnesses.
\}\~
~u_~
r7r~
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SSe
I, Ellena M. Viering, Testatrix whose name is signed ,to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; 'that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
'Z~CA
Ellena M.
Sworn or affirmed to and
acknowledged before me, by
Ellena M. Viering thisJW1~ay
'of i'J.l.f-li.UJf , 1988.
~ J'k~"" /i.-. 'V-
Notary P lic t7( SEAl'?)
My c;oIfu"!lission Expires: 14~-I- 3i /99.:<...
. "Cl)t-:MCNWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SSe
PS'~'..)rn or affirmed to
sucscribed before me
-&tu-A. :z:>~~
~ u.... $1",",-
this .31)-Ih.. day of
We, 1t/~ 74. D,~~~ and I/~i:'~ ~f-~
the witnesses whose names are signed to the ttached or .
foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw Ellena M. Viering
sign and execute the instrument as her Last Will; that Ellena M.
Viering signed willingly and that Ellena M. Viering executed 'as
her free and VOluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed
the will as witnesses; and that to the best of our knowledge,
the Testatrix was at that time eighteen (18) or more years of
age, of sound mind and under no constraint or undue influence.
\~~~~
Z~-' ~
and
by
and
, witnesses,
;4 1-L!'tuJr ,
1988.